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KINGS PARK SLOPE INC
DSH330236 NewYork-Presbyterian/Brooklyn Methodist
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Covered Entity Details
Entity Name
NewYork-Presbyterian/Brooklyn Methodist
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330236
Entity Address
506 SIXTH STREET
BROOKLYN, NY 11215
Medicare Provider Number
330236
Participating Start Date
10/1/2004
Last Recertification Date
9/6/2022
Entity Termination Date
10/1/2022
Pharmacy Details
Pharmacy Name
KINGS PARK SLOPE INC
Pharmacy Address
D/B/A KINGS SUPER PHARMACY
357 FLATBUSH AVE
BROOKLYN, NY 11238
Pharmacy Comments
Contract Details
Approval Date
5/23/2011
Contract Begin Date
5/23/2011
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/30/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
COLLEN MCMANUS, VICE PRESIDENT
(718) 780-3000
Contract Pharmacy Representative
RON DELGUADIO, President/CEO
(718) 230-3535
Signed By Date
5/20/2011
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